8/1/2016

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Presenters:

Renee Barnwell, RN, MSN, RN, CHPN

Rebekah Ellsworth, RN, MSN, CHPCA

HRSA-NEPQR IPCP Grant # UD7HP26048

Enhancing Interprofessional

Collaborative Practice in End

of Life Care

Enhancing Interprofessional

Collaborative Practice in

Hospice & Palliative Care

o HRSA NEPQR-IPCP Grant

Awarded July 2013 - June 2016

Four Seasons ~ Compassion for Life

o Institute of Medicine (IOM)Study on

Interprofessional Education

• Education

• Practice Model

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Project Goals

1. Enhance an existing Interdisciplinary

Teams practice model into a robust

interprofessional collaborative practice

(IPCP) model designed specifically for

delivery of care to patients with advanced

and/or life-limiting illness.

2. Implement this IPCP model for Hospice

and Palliative Care in a large service area

that is predominantly rural and

underserved

Project Goals

3. Strengthen the IPCP model through

systematic development of nurse

leadership, team competency, and

dissemination and replication of the

model in order to improve patient and

population outcomes

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Project Objectives

> Increase IPCP competency among an

interdisciplinary team of HPC providers

(nurses, nursing assistants, nurse

practitioners, physicians, physical

therapists, respiratory therapists,

social workers, chaplains, music

therapists, and students of all

disciplines) using existing IDT

structure and process.

> Establish methods through which

nurses and nursing students develop

leadership skills in interprofessional

team-building, problem-solving, and

care coordination, thus creating an

enduring structure for nurse

leadership, and thereby quality, in HPC.

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> Improve patient- and population-

centered health outcomes by

enhancing the existing IDT model for

HPC and expanding it in an IPCP

environment in a larger service area in

which patients are (a) predominantly

rural and underserved, and (b) seen in

diverse care settings.

> Disseminate best practices in IPCP

through Four Seasons’ Center of

Excellence (COE), which offers high-

quality experiential programs for HPC

providers and organizations.

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Model Development

Registered Nurses Spiritual Care Counselor

Nurse Practitioner Licensed Clinical Social Worker

Certified Nurse Assistant Medical Doctor

Volunteer Patient-Family

Advisor

Music Therapist

Actions to Create IPCP Model for EOL Care

The Project Team Includes:

Project Team Organized and

Trained

Literature review

Systems Assessments Systemic Collaboration

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.

.

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.

Collaborative, Trans-disciplinary CareProfessional Boundary

Hospice Interdisciplinary Team

*specific to Four Seasons, but not all hospice agencies

Nurse Medical Social Worker

Nurse Practitioner* Spiritual Care Counselor

Hospice Aide Bereavement Counselor

Physician Music Therapist*

Volunteer Patient Family Advisor*

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Palliative Care Team

Physician Medical Social Worker

Nurse Practitioner Nurse

Spiritual Care Counselor

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IPCP Competencies

Teamwork:Apply relationship-building values and the principles of

team dynamics to perform effectively in different

team roles to plan and deliver patient-/population-

centered care that is safe, timely, efficient, effective,

and equitable

Roles & Responsibilities:Use the knowledge of one’s own role and those of

other professions to appropriately assess and

address the healthcare needs of the patients and

populations served

IPCP Competencies

Values & Ethics:Work with individuals of other professions to maintain

a climate of mutual respect and shared values

Communication & Collaboration:Communicate with patients, families, communities, and

other health professionals in a responsive and

responsible manner that supports a team approach

to the maintenance of health and the treatment of

disease.

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Four Seasons’ Values

o Compassion: A companion for the journey

o Balance: Seek harmony of mind, body, and spirit

o Respect: Each person is honored

o Integrity: Be trustworthy in all things

o Teamwork: Together everyone achieves more

o Excellence: Dream more (than others think is

practical) Expect more (than others think is possible)

o Resilience: Recover and Thrive from any

Challenge or Change

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Aromatherapy,

Art, Mental

Health,

Massage, Music,

Pet, Reiki,

Wound, etc…

Medical:

Referring, Attending,

Consulting

.

Pharmacy:

Compounding, PBM, Retail,

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Interprofessional Collaborative

Practice: Defining & Assessing

Interprofessional collaborative practice: “When

multiple health workers from different

professional backgrounds work together with

patients, families, carers [sic], and communities to

deliver the highest quality of care” (WHO, 2010)

Interprofessionality:

beyond multi-disciplinary

Interprofessionality: “the process by which

professionals reflect on and develop ways of

practicing that provide an integrated and cohesive

answer to the needs of the client/family/population…

[I]t involves continuous interaction and knowledge

sharing between professionals, organized to solve or

explore a variety of education and care issues all while

seeking to optimize the patient’s participation…

Interprofessionality requires a paradigm shift, since

interprofessional practice has unique characteristics in

terms of values, codes of conduct, and ways of

working. These characteristics must be elucidated”

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IPCP Professional Development

oAssess•Individual and Team evaluation of Competency

levels• Novice, Proficient, Expert

•Self & Observed Assessments

•Ongoing observation and assessment of

competence

oEducate•IPCP Model

•Competencies, Definitions, and Behaviors

•Provide Reflective Practice Space

IPCP Professional Development

oEducate•3 C’s

(Communication, Consultation and Collaboration)

•SBAR

•TeamSTEPPS

•Preceptor Program

•Grand Rounds

•Patient and Family Advisor (PFA)

Recruitment, Orientation, Training, Feedback

•Facilitator Training

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Structures & Processes

to Enhance IPCP

oIPCP Project Team Specialists

oNursing Leadership

•IPCP Specialists

•Care Experience Coordinator

oPatient and Family Advisor Role

oInterdisciplinary Team (IDT) Meeting

Best Practices

oSustaining IPCP

IPCP Impact Potential

oOutcomes Identified•Patient & Family Outcomes

•Pain, Dyspnea management, CAHPS, Service Recovery, QDACT

•Competency Development

•Self , Team, and Observed Assessments

•Meeting Ratings

oOutcomes Current Reality•Seeing improvements in most areas

•Above national benchmarks on CAHPS

•Competency Assessments more realistic with

increased understanding

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Grant ManagementoInternal &/or External Resources:

•Agency Support

•Searching & Writing grant applications

oGrants.gov•Registration

•Search grant opportunities & Guidance

oSteering & Project Team•Selection

•Functions

•Accountability

Grant ManagementoReporting to Grantor

•Training & Support

•Translate Grantor language

•Financial & Progress Reports

•Audits

Audit & Monitor internally

Work plan

Budget

Outcomes

Federal audit:

https://www.whitehouse.gov/omb/grants_docs/

Agency General Financial Audit

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Discussion & Questions….

References

D’Amour, D. & Oandasan, I. (2005). Interprofessionality as the field

of interprofessional practice and interprofessional education:

An emerging concept. Journal of Interprofessional Care, 19

(Supplement 1), 8-20

HPNA. (2010). Professional competencies for the generalist

hospice and palliative nurse. (2nd Ed.). Dubuque, IA:

Kendall/Hunt Publishing Company.

Interprofessional Education collaborative Expert Panel. (2011).

Core competencies for interprofessional collaborative practice.

Report of an expert panel. Washington, DC. Interprofessional

Education Collaborative.

Institute of Medicine (IOM) Consensus Committee Report. (2015).

Measuring the Impact of IPE on Collaborative Practice and

Patient Outcomes.

https://iom.nationalacademies.org/Reports/2015/Impact-of-

IPE.aspx

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References

National Quality Forum. (2006). A national framework for preferred

practices for palliative and hospice care quality: A consensus

report. Retrieved from

http://www.qualityforum.org/Publications/2006/12/A_National_F

ramework_and_Preferred_Practices_for_Palliative_and_Hospic

e_Care_Quality.aspx

World Health Organization (WHO). (2010). Framework for action on

interprofessional education & collaborative practice. Geneva:

World Health Organization. Retrieved April 19, 2016 from

http://www.who.int/hrh/resources/framework_action/en/

HRSA Grant Project Statement

This project is supported by the Health Resources

and Services Administration (HRSA) of the U.S. Department

of Health and Human Services (HHS) under grant number

UD7HP26048; HRSA-NEPQR Interprofessional

Collaborative Practice Project, Advancing Interprofessional

Collaborative Practice in Hospice and Palliative Care; total

award amount $1,419,046, 100% financed with HRSA

government support and 0% financed with non-

governmental sources.

This information, content and conclusions are those of

the authors, Four Seasons~Compassion for Life IPCP

Project Team, and should not be construed as the official

position or policy of, nor should any endorsements be

inferred by HRSA , HHS, or the U.S. Government.